Specific conditions Smoke inhalation

• Smoke rarely causes thermal injury beyond the level of bronchi as it has a low specific heat content. However, soot is a major irritant to the upper airways and can produce very rapid and marked inflammation.

• Urgent laryngoscopy should be performed if soot is present in the nares, mouth or pharynx.

• If soot is seen or the larynx appears inflamed, perform early endotracheal intubation. As the upper airway can obstruct within minutes it is advisable to intubate as a prophylactic measure rather than as an emergency where it may prove impossible.

• After intubation, perform urgent bronchoscopy with bronchial toilet using warmed 0.9% saline to remove as much soot as possible.